attachment - required state agency findings...the applicants relied on data from a north carolina...
Post on 13-Jul-2020
0 Views
Preview:
TRANSCRIPT
ATTACHMENT - REQUIRED STATE AGENCY FINDINGS
FINDINGS
C = Conforming
CA = Conditional
NC = Nonconforming
NA = Not Applicable
Decision Date: March 29, 2019
Findings Date: March 29. 2019
Project Analyst: Gregory F. Yakaboski
Assistant Chief: Lisa Pittman
Project ID #: F-11607-18
Facility: Liberty Commons Nursing & Rehabilitation Center of Mint Hill
FID #: 180101
County: Mecklenburg
Applicant(s): Liberty Commons of Mecklenburg, LLC
Mecklenburg County Healthcare Properties, LLC
Project: Relocate 12 ACH beds from Radbourne Manor Village (Project I.D. #F-11052-15)
to Liberty Commons Nursing & Rehabilitation Center of Mint Hill (Project I.D.
#F-11461-18) for a total of 83 NF beds and 12 ACH beds upon project completion
REVIEW CRITERIA FOR NEW INSTITUTIONAL HEALTH SERVICES
N.C. Gen. Stat. §131E-183(a) The Agency shall review all applications utilizing the criteria outlined
in this subsection and shall determine that an application is either consistent with or not in conflict
with these criteria before a certificate of need for the proposed project shall be issued.
(1) The proposed project shall be consistent with applicable policies and need determinations in
the State Medical Facilities Plan, the need determination of which constitutes a determinative
limitation on the provision of any health service, health service facility, health service facility
beds, dialysis stations, operating rooms, or home health offices that may be approved.
C
The applicants, Liberty Commons of Mecklenburg, LLC and Mecklenburg County Healthcare
Properties, LLC propose a change of scope (COS) for the approved, but undeveloped, Liberty
Commons Nursing & Rehabilitation Center of Mint Hill (Liberty Commons of Mint Hill)
project [Project I.D. # F-11461-18], which authorized the construction of a new 83-bed nursing
facility at 7712 Wilson Grove Road in Mint Hill. Specifically, in the original approved
application, the applicants proposed to develop a new 83-bed nursing facility by relocating five
nursing facility beds from Warren Hills (Warren County), ten beds from Cross Creek (Hyde
County), 20 beds from Bermuda Commons (Davie County), 22 beds from Mary Gran
(Sampson County), seven beds from Liberty Commons of Columbus (Columbus County), nine
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 2
beds from Shoreland (Columbus County), and ten beds from Legion Road Healthcare (Orange
County).
In the current COS application, the applicants propose to add 12 ACH beds to the approved
Liberty Commons of Mint Hill project by relocating 12 ACH beds from Radbourne Manor
Village (Project I.D. #F-11052-15) project for a total of 83 NF beds and 12 ACH beds at
Liberty Commons of Mint Hill upon project completion. Further, operating year (OY) one
for the overall project (Project I.D. #F-11461-18 and this proposed project) will be full fiscal
year (FFY) 2025 (10/1/2024 – 9/30/2025) instead of FFY 2024 (10/1/2023 – 9/30/2024).
Need Determination
The proposed project does not involve the addition of any new health service facility beds,
services or equipment for which there is a need determination in the 2018 State Medical
Facilities Plan (2018 SMFP). Therefore, there are no need determinations applicable to this
review.
Policies
The applicant was found confirming to the following policies in Project ID #F-11461-18:
Policy NH-6: Relocation of Nursing Facility Beds
Policy NH-8: Innovations in Nursing Facility Design
Policy GEN-4: Energy Efficiency and Sustainability for Health Service Facilities
In the current COS application, Policy LTC-2: Relocation of Adult Care Home Beds in the
2018 SMFP is applicable to this review.
Policy LTC-2: Relocation of Adult Care Home Beds states:
“Relocations of existing licensed adult care home beds are allowed only within the host
county and to contiguous counties. Certificate of need applicants proposing to relocate
licensed adult care home beds to a contiguous county shall:
1. Demonstrate that the facility losing beds or moving to a contiguous county is
currently serving residents of that contiguous county; and
2. Demonstrate that the proposal shall not result in a deficit, or increase an existing
deficit in the number of licensed adult care home beds in the county that would be
losing adult care home beds as a result of the proposed project, as reflected in the North
Carolina State Medical Facilities Plan in effect at the time the certificate of need review
begins; and
3. Demonstrate that the proposal shall not result in a surplus, or increase an existing
surplus of licensed adult care home beds in the county that would gain adult care home
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 3
beds as a result of the proposed project, as reflected in the North Carolina State Medical
Facilities Plan in effect at the time the certificate of need review begins.”
Both the existing and proposed locations for the 12 ACH beds are in Mecklenburg County.
The application is consistent with Policy LTC-2.
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the application is conforming to this criterion
and Policy LTC-2.
(2) Repealed effective July 1, 1987.
(3) The applicant shall identify the population to be served by the proposed project, and shall
demonstrate the need that this population has for the services proposed, and the extent to which
all residents of the area, and, in particular, low income persons, racial and ethnic minorities,
women, handicapped persons, the elderly, and other underserved groups are likely to have
access to the services proposed.
C
The applicants propose a COS for the approved, but undeveloped, Liberty Commons of Mint
Hill project which authorized the construction of a new 83-bed nursing facility. In the current
COS application, the applicants propose to add 12 ACH beds to the approved Liberty
Commons of Mint Hill project by relocating 12 ACH beds from Radbourne Manor Village
(Project I.D. #F-11052-15) project for a total of 83 NF beds and 12 ACH beds at Mint Hill
upon project completion.
Patient Origin
On page 211, the 2018 SMFP defines the service area for adult care home beds as “the adult
care home bed planning area in which the bed is located. Ninety-eight counties in the state are
separate adult care home planning areas. Two counties, Hyde and Tyrell, are considered a
combined service area”. Thus, the service area for this facility consists of Mecklenburg
County. Facilities may also serve residents of counties not included in their service area.
In Section C.3, pages 20-21, the applicants provide the projected patient origin for the 12 ACH
beds that are being proposed to be relocated to Liberty Commons of Mint Hill, as summarized
below.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 4
Liberty Commons of Mint Hill
Projected Patient Origin for 12 Relocated ACH Beds
General ACH Beds
County # of Patients % of Total
Mecklenburg 11 92%
Union/Cabarrus/Stanly 1 8%
TOTAL 12 100%
Source: Application, page 20
Totals may not sum due to rounding
In Section C, page 20, the applicants provide the assumptions and methodology used to project
its patient origin. The applicant’s assumptions are reasonable and adequately supported.
Analysis of Need
In Section C.4, pages 21-23, and supplemental information, the applicant explains why it
believes the population projected to utilize the proposed services needs the proposed services.
On page 21, the applicants state:
“The key factors that drive the need for the proposed project are as follows:
Lack of ACH care in combination facilities
Lack of placement options for Mecklenburg County special assistance/Medicaid
residents
Mecklenburg County’s growing senior population”
The information is reasonable and adequately supported for the following reasons:
The 12 ACH beds are existing and only being relocated within Mecklenburg County and
therefore are not adding to the projected surplus in Mecklenburg County.
There are only 13 facilities in Mecklenburg County that have both NF and ACH beds and
of the 13 facilities only two offered the combination of nursing facility and adult care that
Liberty Commons of Mint Hill is projecting to provide.
The applicants demonstrate that based on the North Carolina Office of State Budget and
Management (NCOSBM) estimates, Mecklenburg County’s total population of seniors
(aged 65 and older and the age cohort most likely to utilize ACH beds) is expected to rise
from 81,931 individuals in 2010 to 205,624 in 2030, an increase of approximately 153%.
The applicants demonstrate that based on a review of the 2018 License Renewal
Applications (LRAs) of 37 ACH facilities in Mecklenburg County 78% of the days of care
were private pay and only 22% were for county assistance whereas according to a North
Carolina assisted living fact sheet from the National Center for Assisted Living (NCAL)
44% of residents rely on Medicaid (county assistance) for their care.
Projected Utilization
In Section Q and supplemental information, the applicants provide projected utilization as
illustrated in the following table(s).
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 5
Liberty Commons of Mint Hill – Projected Utilization
OY1
10/1/24-9/30/25
OY2
10/1/25-9/30/26
OY3
10/1/26-9/30/27
NF Beds
# of NF Beds 83 83 83
# of Patient Days 22,865 28,182 28,182
Occupancy Rate 75.47% 93.03% 93.03%
ACH Beds
# of ACH Beds 12 12 12
# of Patient Days 3,250 4,026 4,026
Occupancy Rate 74.20% 91.92% 91.92%
In Section Q and supplemental information, the applicant provides the assumptions and
methodology used to project utilization, which is summarized below.
Liberty opened a 30 ACH bed facility in Mecklenburg County, The Terrace at
Brightmore of South Charlotte, in April, 2015. The applicants utilized the census data
from that project to project utilization for this proposed project. The applicants state
that the census at The Terrace at Brightmore of South Charlotte has consistently stayed
at capacity. For the proposed Liberty Commons of Mint Hill project the applicants
state that they proposed a slightly faster fill up rate because of the fact that the 12 ACH
beds will be in a combination facility and will be projecting 36% State/County
assistance.
According to the US Census Bureau, the poverty rate for seniors in North Carolina is
around 10%;
By 2022 there will be approximately 150,000 seniors living in Mecklenburg County
(NCOSBM).
Approximately 15,000 seniors living in Mecklenburg County will be living below the
poverty rate by the year 2022 (150,000 x .10 = 15,000).
Currently there are only approximately 3,000 ACH beds in Mecklenburg County and
only 22% of the patient days are county assistance/Medicaid patients.
In addition, the applicants relied on additional utilization census from other facilities
currently operated by Liberty. See Section A.10, pages 9-11, for a list of both the 26
nursing facilities and 4 adult care home facilities owned or operated by the applicant or
related entity.
Projected utilization is reasonable and adequately supported for the following reasons:
The applicants relied on historical data/experience and current data from a different
existing Liberty ACH facility also located in Mecklenburg County
The applicants relied on utilization census from other Liberty operated facilities.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 6
The fill-up rate is reasonable based on the management company’s experience and the
applicants projected need.
The applicants relied on data from a North Carolina assisted living fact sheet from the
National Center for Assisted Living (NCAL), the US Census Bureau and the North
Carolina Office of State Budget and Management.
Access
In Section C, page 25, the applicant states Liberty Commons of Mint Hill will provide services
to all persons without discrimination on the basis of “social, racial, ethnic, or gender related
issues.” In Section L, page 52, the applicants project the following payor mix during the third
full fiscal year of operation following completion of the project, as illustrated in the following
table.
Liberty Commons of Mint Hill: 12 ACH Beds- Third FFY (10/1/2026 – 9/30/27)
Payor Category Services as Percent of Total ACH
Services
Private Pay 64%
County Assistance/Medicaid 36%
Total 100%
Source: Table on page 52
The projected payor mix is reasonable and adequately supported.
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the application is conforming to this criterion
for the following reasons:
The applicants adequately identify the population to be served.
The applicants adequately explain why the population to be served needs the services
proposed in this application.
Projected utilization is reasonable and adequately supported.
The applicants project the extent to which all residents, including underserved groups, will
have access to the proposed services (payor mix) and adequately supports its assumptions.
(3a) In the case of a reduction or elimination of a service, including the relocation of a facility or a
service, the applicant shall demonstrate that the needs of the population presently served will
be met adequately by the proposed relocation or by alternative arrangements, and the effect of
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 7
the reduction, elimination or relocation of the service on the ability of low income persons,
racial and ethnic minorities, women, handicapped persons, and other underserved groups and
the elderly to obtain needed health care.
C
In Project I.D. # F-11461-18, the applicants were found conforming with this criterion.
In the current application, the applicants propose a COS for the approved, but undeveloped,
Liberty Commons of Mint Hill project which authorized the construction of a new 83-bed
nursing facility. In the current COS application, the applicants propose to add 12 ACH beds to
the approved Liberty Commons of Mint Hill project by relocating 12 ACH beds from
Radbourne Manor Village (Project I.D. #F-11052-15) project a total of 83 NF beds and 12
ACH beds at Liberty Commons of Mint Hill upon project completion.
In Section D, page 31, and supplemental information, the applicants explain why they believe
the needs of the population presently utilizing the services to be reduced, eliminated or
relocated will be adequately met following completion of the project. On page 31, the
applicants state:
“The relocation of these ACH beds will not have any negative effect, as there are no
patients currently utilizing these beds. No facility is losing beds, as Radbourne Manor
Village III is currently closed.”
In Section D, page 31, the applicant states “In fact, it will only have a positive effect as it will
put 12 AL beds into service. Additionally, this will have a positive effect on all groups listed
in Section D.4, as a projected 36.36% of the ACH residents will be county assistance/Medicaid
payers.”
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the applicant adequately demonstrates that:
The needs of the population currently using the services to be reduced, eliminated or
relocated will be adequately met following project completion.
The project will not adversely impact the ability of underserved groups to access these
services following project completion.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 8
(4) Where alternative methods of meeting the needs for the proposed project exist, the applicant
shall demonstrate that the least costly or most effective alternative has been proposed.
CA
In the current application, the applicants propose a COS which would allow the applicants to
relocate 12 ACH beds from Radbourne Manor Village (Project I.D. #F-11052-15) to the
approved Liberty Commons of Mint Hill (Project I.D. #F-11461-18) for a total of 83 NF beds
and 12 ACH beds upon project completion.
In Section E, page 32, and supplemental information, the applicants describe the alternatives
it considered and explains why each alternative is either more costly or less effective than the
alternative proposed in this application to meet the need. The alternatives considered were:
Moving the 12 ACH beds to Royal Park of Matthews- This alternative would have
required building onto the current community at a high capital cost. Therefore, this was
not the least costly or most effective alternative.
Moving the 12 ACH beds to The Pavilion at Brightmore of South Charlotte- This
alternative would have required building onto the current community at a high capital
cost. Therefore, this was not the least costly or most effective alternative.
Moving the 12 ACH beds to Liberty Commons of Mecklenburg- The applicants state
that based on its experience nursing facilities and combination nursing/adult care bed
facilities operate best when licensed for between 90-100 beds. In addition, this
approved facility is located in Deweese township and is expected to have a growth of
917 people in the 65+ age bracket as compared to Clear Creek Township (where
Liberty Commons of Mint Hill will be located) which is expected to have a growth of
1050 people in the 65+ age bracket. There, this was not the most effective alternative.
On page 32, and supplemental information, the applicants state that its proposal is the most
effective alternative for two reasons: First, the overall number of beds: adding 12 ACH beds
to the already approved 83 NF beds puts Liberty Commons of Mint Hill at a total of 95 beds.
Based on the experience of its operators, the applicants are aware that facilities run the
smoothest when licensed from 90-110 beds. If the 12 ACH beds were added to Liberty
Commons of Mecklenburg it would put that facility at over 110 beds (112) while keeping
Liberty Commons of Mint Hill below 90 beds (83). Second, the expected increase in the
population age 65+, the age cohort most likely to utilize the ACH beds, in Deweese Township
(Liberty of Mecklenburg location) is projected to have a smaller amount of growth in the 65+
age population as compared to Clear Creek Township (Mint Hill location).
The applicants adequately demonstrate that the alternative proposed in this application is the
most effective alternative to meet the need for the following reasons:
The application is conforming to all statutory and regulatory review criteria.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 9
The applicants provide credible information to explain why they believe the proposed
project is the most effective alternative.
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information which was publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the application is conforming to this criterion
for the reasons stated above. Therefore, the application is approved subject to the following
conditions:
1. Liberty Commons of Mecklenburg, LLC and Mecklenburg County
Healthcare Properties, LLC shall materially comply with the representations in
this application, the representations in Project I.D. #F-11461-18 and any
supplemental responses. Where representations conflict, Liberty Commons of
Mecklenburg, LLC and Mecklenburg County Healthcare Properties, LLC
shall materially comply with the last made representation.
2. Liberty Commons of Mecklenburg, LLC and Mecklenburg County
Healthcare Properties, LLC shall relocate 12 ACH beds from Radbourne
Manor Village (Project I.D. #F-11052-15) to the approved, but undeveloped,
Liberty Commons Nursing & Rehabilitation Center of Mint Hill (Project I.D.
#F-11461-18) for a total of 83 NF beds and 12 ACH beds upon project
completion.
3. Upon completion of the project, Liberty Commons of Mint Hill shall be
licensed for no more than 83 nursing facility beds and 12 adult care home beds.
4. Liberty Commons of Mecklenburg, LLC and Mecklenburg County
Healthcare Properties, LLC shall provide care to recipients of State/County
Special Assistance with Medicaid, commensurate with representations made
in the application.
5. For the first two years of operation following completion of the project, Liberty
Commons of Mecklenburg, LLC and Mecklenburg County Healthcare
Properties, LLC shall not increase private pay charges more than 5% of the
projected private pay charges provided in Section Q of the application without
first obtaining a determination from the Healthcare Planning and Certificate of
Need Section that the proposed increase is in material compliance with the
representations in the certificate of need application.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 10
6. No later than three months after the last day of each of the first three full years
of operation following initiation of the services authorized by this certificate of
need, Liberty Commons of Mecklenburg, LLC and Mecklenburg County
Healthcare Properties, LLC shall submit, on the form provided by the
Healthcare Planning and Certificate of Need Section, an annual report
containing the:
a. Payor mix for the services authorized in this certificate of need.
b. Utilization of the services authorized in this certificate of need.
c. Revenues and operating costs for the services authorized in this
certificate of need.
d. Average gross revenue per unit of service.
e. Average net revenue per unit of service.
f. Average operating cost per unit of service.
7. Liberty Commons of Mecklenburg, LLC and Mecklenburg County
Healthcare Properties, LLC shall acknowledge acceptance of and agree to
comply with all conditions stated herein to the Agency in writing prior to
issuance of the certificate of need.
(5) Financial and operational projections for the project shall demonstrate the availability of funds
for capital and operating needs as well as the immediate and long-term financial feasibility of
the proposal, based upon reasonable projections of the costs of and charges for providing health
services by the person proposing the service.
C
The applicants propose a COS for the approved, but undeveloped, Liberty Commons of Mint
Hill project which authorized the construction of a new 83-bed nursing facility. In the current
COS application, the applicants propose to add 12 ACH beds to the approved Liberty
Commons of Mint Hill project by relocating 12 ACH beds from Radbourne Manor Village
(Project I.D. #F-11052-15) project for a total of 83 NF beds and 12 ACH beds at Liberty
Commons of Mint Hill upon project completion.
In the original Liberty Commons of Mint Hill project, Project I.D. # F-11461-18, the
application was conforming to this criterion with approved capital costs of $15,307,416 and
working capital costs of $738,624, as shown below.
Capital and Working Capital Costs
In Section Q, Form F.1b, page 65, the applicants project the total capital cost of this project
(add 12 ACH beds) as shown in the table below.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 11
Original Costs (Project
ID# F-11461-18)
Additional Costs for
12 ACH Beds
Total
Site Preparation Costs $2,005,166 $0.00 $2,005,166
Construction Costs $11,838,750 $700,000 $12,538,750
Miscellaneous Costs $1,463,500 $177,000 $1,640,500
Total $15,307,416 $877,000 $16,184,416
In Section Q, the applicants provide the assumptions used to project the capital cost.
In supplemental information, the applicants project that start-up costs associated with the COS
application over and above the original working capital costs of $738,624 will be $36,286 to
cover additional staffing and operating expenses during the fill-up of the 12 ACH beds.
Availability of Funds
In Section F, page 33, and supplemental information, the applicants state that the capital cost
will be funded as shown in the table below.
Sources of Capital Cost Financing
Type Mecklenburg County Healthcare Properties, LLC Total
Loans $ $
Accumulated reserves or OE * $877,00 $877,000
Bonds $ $
Other (Specify) $ $
Total Financing $877,000 $877,00
* OE = Owner’s Equity
In Section F, page 35, and in supplemental information, the applicants state that the working
capital needs of the project will be funded as shown in the table below.
Sources of Financing for Working Capital Amount
(a) Loans $
(b) Cash or Cash Equivalents, Accumulated Reserves or Owner’s Equity $36,286
(c) Lines of credit $
(d) Bonds $
(e) Total * $36,286
In Section F, pages 33 and 35, the applicants state that the capital costs will be financed by the
owner’s equity of John A. McNeill, Jr. and Ronald B. McNeill, owners of the applicants. In
supplemental information, the applicants provide a letter dated January 14, 2019, from John
A. McNeill, Jr. and Ronald B. McNeill expressing their intention to fund the capital and
working capital costs for the proposed project. The applicants, in supplemental information,
also included a letter dated March 19, 2019 from Joel M. White, CPA of the accounting firm
Cherry Bekaert, which states that John A. McNeill, Jr. and Ronald B. McNeill have adequate
funds to meet the capital and working capital requirements of the proposed project. The
applicants adequately demonstrate that sufficient funds will be available for the capital needs
of the proposed project.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 12
Financial Feasibility
The applicant provided pro forma financial statements for the first three full fiscal years of
operation following completion of the project. In Form F.5 and supplemental information the
applicant projects that revenues will exceed operating expenses in the first three operating years
of the project, as shown in the table below.
Liberty Commons of Mint Hill: Entire Facility (NF and ACH beds) 1st Full Fiscal
Year
2nd Full Fiscal
Year
3rd Full Fiscal
Year
Total Patient Days 26,115 32,208 32,208
Total Gross Revenues (Charges) $6,971,138 $8,700,243 $8,814,930
Total Net Revenue $6,213,523 $7,766,236 $7,880,694
Average Net Revenue per Patient Days $237.93 $241.13 $244.68
Total Operating Expenses (Costs) $5,888,274 $6,294,265 $6,413,115
Average Operating Expense per Patient Days $225.48 $195.43 $199.16
Net Income $325,249 $1,471,972 $1,467,579
The assumptions used by the applicants in preparation of the pro forma financial statements
are reasonable, including projected utilization, costs and charges. See Section Q of the
application and supplemental information for the assumptions used regarding costs and
charges. The discussion regarding projected utilization found in Criterion (3) is incorporated
herein by reference.
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the application is conforming to this criterion
for the following reasons:
The applicants adequately demonstrate that the capital and working capital costs are based
on reasonable and adequately supported assumptions.
The applicants adequately demonstrate availability of sufficient funds for the capital
and working capital needs of the proposal.
The applicants adequately demonstrate sufficient funds for the operating needs of the
proposal and that the financial feasibility of the proposal is based upon reasonable
projections of costs and charges.
(6) The applicant shall demonstrate that the proposed project will not result in unnecessary
duplication of existing or approved health service capabilities or facilities.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 13
C
The applicants propose a COS for the approved, but undeveloped, Liberty Commons of Mint
Hill project which authorized the construction of a new 83-bed nursing facility. In the current
COS application, the applicants propose to add 12 ACH beds to the approved Liberty
Commons of Mint Hill project by relocating 12 ACH beds from Radbourne Manor Village
(Project I.D. #F-11052-15) project for a total of 83 NF beds and 12 ACH beds at Liberty
Commons of Mint Hill upon project completion.
On page 211, the 2018 SMFP defines the service area for adult care home beds as “the adult
care home bed planning area in which the bed is located. Ninety-eight counties in the state are
separate adult care home planning areas. Two counties, Hyde and Tyrell, are considered a
combined service area”. Thus, the service area for this facility consists of Mecklenburg
County. Facilities may also serve residents of counties not included in their service area.
Based on data in Table 11A: Inventory of Adult Care Homes (Assisted Living) Beds in the
2018 SMFP, pages 226-228, Mecklenburg County has a total of 50 facilities with ACH beds
with a total planning inventory of 3,305 ACH beds including ACH beds with Agency approval
or license pending minus exclusions. Also, based on data in Table 11B: Adult Care Home
Need Projections for 2021 in the 2018 SMFP, page 239, Mecklenburg County is projected to
have an adult care home bed surplus of 360 beds in 2021.
In Section G, page 41, the applicants explain why they believe their proposal would not result
in the unnecessary duplication of existing or approved adult care services in Mecklenburg
County. The applicants state:
“The Applicants’ proposed change of scope project does not seek to increase the number
of ACH beds in the Mecklenburg County SMFP inventory. Rather, the Applicants propose
to relocate already existing ACH beds in the (Mecklenburg) SMFP inventory… no new
beds will be added to adult care home bed inventory in the SMFP.”
The applicants adequately demonstrate that the proposal would not result in an unnecessary
duplication of existing or approved services in the service area because the proposal would not
result in an increase in adult care home beds in Mecklenburg County, but rather relocate
existing adult care home beds within Mecklenburg County.
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information publicly available during the review and used by the Agency
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 14
Based on that review, the Agency concludes that the application is conforming to this criterion
for the reasons stated above.
(7) The applicant shall show evidence of the availability of resources, including health manpower
and management personnel, for the provision of the services proposed to be provided.
C
In Section H.5, page 43, Section Q, Form H, page 85 and supplemental information, the
applicants provide current and projected full-time equivalent (FTE) staffing for the proposed
services, as illustrated in the following table.
Liberty Commons of Mint Hill: Projected Staffing for OY2 (10/1/25 to 9/30/26)
Position Projected
NF Beds ACH Beds Total
Facility
Director of Nursing 1.00 0.00 1.00
MDS Nurse 1.00 0.00 1.00
Registered Nurse 5.60 0.00 5.60
Licensed Practical Nurse 12.60 1.95 15.40
CNAs 30.80 4.24 33.60
Ward Secretary 0.50 0.00 0.50
Medical Records 1.00 0.00 1.00
Social Services 1.00 0.00 1.00
Activities Director 0.87 0.13 1.00
Housekeeping 0.87 0.13 1.00
Housekeeping Aides 4.89 0.71 5.60
Laundry Aides 2.45 0.35 2.80
Physical Therapist 2.00 0.00 2.00
Physical Therapist Assistant 2.40 0.00 2.40
Physical Therapist Aides 1.00 0.00 1.00
Occupational Therapist 1.00 0.00 1.00
Speech Therapist 0.50 0.00 0.50
Certified Occupational Therapist Assistant 1.60 0.00 1.60
Maintenance Supervisor 0.87 0.13 1.00
Janitors 0.87 0.13 1.00
Transportation 0.87 0.13 1.00
Administration 0.87 0.13 1.00
Business Office Manager 0.87 0.13 1.00
Other: Business Office Staff 0.87 0.13 1.00
TOTAL 76.30 8.29 84.00
Source: Form H in Section Q of the application and supplemental information.
The assumptions and methodology used to project staffing are provided in Section H, Form H
and in supplemental information. Adequate costs for the health manpower and management
positions proposed by the applicant are budgeted in Form F.4, which is found in Section Q. In
Section H, page 43 and in supplemental information, respectively, the applicants describe the
methods to be used to recruit or fill new positions and its proposed training and continuing
education programs. In Section H, page 43, and in supplemental information, the applicants
identify the proposed medical director. In supplemental information, the applicants provide a
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 15
letter from the proposed medical director indicating an interest in serving as medical director
for the proposed services.
The applicants adequately demonstrate the availability of sufficient health manpower and
management personnel to provide the proposed services.
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information which was publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the application is conforming to this criterion
for the reasons stated above.
(8) The applicant shall demonstrate that the provider of the proposed services will make available,
or otherwise make arrangements for, the provision of the necessary ancillary and support
services. The applicant shall also demonstrate that the proposed service will be coordinated
with the existing health care system.
C
In Section I, page 45, the applicant states,
“The applicants adequately demonstrated in [sic] approved application that the necessary
ancillary and support services will be available and that proposed services will be
coordinated with the existing health care system. Nothing has changed for this application.”
In Project I.D. # F-11461-18, the application was conforming to this criterion.
In supplemental information the applicants state that the following ancillary and support
services are necessary for the proposed services:
Inpatient Nursing Care
Dietician
Audiology
Physician Services
Podiatry
Respiratory Care
Laboratory
Dentistry
Pharmacy
Non-emergency Medical Transport
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 16
Facility Van
Mental Health/Behavioral Program
Personal Laundry
Pastoral/Chaplaincy
Speech Therapy
Rehab Services
Therapeutic
Housekeeping
In supplemental information, the applicants adequately explain how each ancillary and support
service is or will be made available.
In supplemental information, the applicants describe the efforts to develop relationships with
other local health care and social service providers.
The applicants adequately demonstrate that the proposed services will be coordinated with the
existing health care system.
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information which was publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the application is conforming to this criterion.
(9) An applicant proposing to provide a substantial portion of the project's services to individuals
not residing in the health service area in which the project is located, or in adjacent health
service areas, shall document the special needs and circumstances that warrant service to these
individuals.
NA
The applicants do not project to provide the proposed services to a substantial number of
persons residing in Health Service Areas (HSAs) that are not adjacent to the HSA in which the
services will be offered. Furthermore, the applicants do not project to provide the proposed
services to a substantial number of persons residing in other states that are not adjacent to the
North Carolina county in which the services will be offered. Therefore, Criterion (9) is not
applicable to this review.
(10) When applicable, the applicant shall show that the special needs of health maintenance
organizations will be fulfilled by the project. Specifically, the applicant shall show that the
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 17
project accommodates: (a) The needs of enrolled members and reasonably anticipated new
members of the HMO for the health service to be provided by the organization; and (b) The
availability of new health services from non-HMO providers or other HMOs in a reasonable
and cost-effective manner which is consistent with the basic method of operation of the HMO.
In assessing the availability of these health services from these providers, the applicant shall
consider only whether the services from these providers:
(i) would be available under a contract of at least 5 years duration;
(ii) would be available and conveniently accessible through physicians and other health
professionals associated with the HMO;
(iii) would cost no more than if the services were provided by the HMO; and
(iv) would be available in a manner which is administratively feasible to the HMO.
NA
The applicants are not HMOs. Therefore, Criterion (10) is not applicable to this review.
(11) Repealed effective July 1, 1987.
(12) Applications involving construction shall demonstrate that the cost, design, and means of
construction proposed represent the most reasonable alternative, and that the construction
project will not unduly increase the costs of providing health services by the person proposing
the construction project or the costs and charges to the public of providing health services by
other persons, and that applicable energy saving features have been incorporated into the
construction plans.
C
In Project I.D. # F-11461-18, the application was conforming to this criterion. In Section K,
that applicants state that there were no changes proposed in this COS application except an
updated floor plan to accommodate the addition of the proposed 12 ACH beds. Line drawings
are provided in Exhibit K.5.
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information which was publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the application is conforming to this criterion.
(13) The applicant shall demonstrate the contribution of the proposed service in meeting the health-
related needs of the elderly and of members of medically underserved groups, such as
medically indigent or low income persons, Medicaid and Medicare recipients, racial and ethnic
minorities, women, and handicapped persons, which have traditionally experienced difficulties
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 18
in obtaining equal access to the proposed services, particularly those needs identified in the
State Health Plan as deserving of priority. For the purpose of determining the extent to which
the proposed service will be accessible, the applicant shall show:
(a) The extent to which medically underserved populations currently use the applicant's
existing services in comparison to the percentage of the population in the applicant's
service area which is medically underserved;
NA
In Project I.D. #F-11461-18, this Criterion was deemed to be not applicable because
the applicant proposed to develop a new facility. The applicant proposes no changes in
the current COS application that would affect that determination.
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information which was publicly available during the review and used by the
Agency
(b) Its past performance in meeting its obligation, if any, under any applicable regulations
requiring provision of uncompensated care, community service, or access by minorities
and handicapped persons to programs receiving federal assistance, including the
existence of any civil rights access complaints against the applicant;
NA
In Project I.D. #F-11461-18, this Criterion was deemed to be not applicable because
the applicant proposed to develop a new facility. The applicants propose no changes in
the current COS application that would affect that determination.
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency (if applicable)
Information which was publicly available during the review and used by the
Agency
(c) That the elderly and the medically underserved groups identified in this subdivision
will be served by the applicant's proposed services and the extent to which each of these
groups is expected to utilize the proposed services; and
C
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 19
In Project I.D. # F-11461-18, the application was conforming to this criterion
The applicants propose a COS for the approved, but undeveloped, Liberty Commons
of Mint Hill project which authorized the construction of a new 83-bed nursing facility.
In the current COS application, the applicants propose to add 12 ACH beds to the
approved Liberty Commons of Mint Hill project by relocating 12 ACH beds from
Radbourne Manor Village (Project I.D. #F-11052-15) project for a total of 83 NF beds
and 12 ACH beds at Liberty Commons of Mint Hill upon project completion.
In Section L, page 52, the applicant projects the following payor mix for the proposed
ACH services during the third full fiscal year of operation following completion of the
project, as shown in the table below.
ACH Beds- Third Full FFY (10/1/2026 – 9/30/2027)
Payor Category Services as Percent of Total ACH
Services
Private Pay 64%
County Assistance/Medicaid 36%
Total 100%
Source: Table on page 52
As shown in the table above, during the third full fiscal year of operation, the applicant
projects that 36% of total ACH services will be provided to patients receiving County
Assistance/Medicaid.
In supplemental information, the applicant provides the assumptions and methodology
used to project payor mix for the proposed ACH services during the third full fiscal
year of operation following completion of the project. The projected payor mix is
reasonable and adequately supported based on the applicants historical business
experience and 2018 LRA data.
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information which was publicly available during the review and used by the
Agency
Based on that review, the Agency concludes that the application is conforming to this
criterion.
(d) That the applicant offers a range of means by which a person will have access to its
services. Examples of a range of means are outpatient services, admission by house
staff, and admission by personal physicians.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 20
C
In Project I.D. # F-11461-18, the application was conforming to this criterion and the
applicants propose no changes in the current COS application that would affect that
determination.
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information which was publicly available during the review and used by the
Agency
Based on that review, the Agency concludes that the applicants adequately document
the extent to which medically underserved populations currently use the applicant's
existing services in comparison to the percentage of the population in the applicant’s
service area which is medically underserved. Therefore, the application is conforming
to this criterion.
(14) The applicant shall demonstrate that the proposed health services accommodate the clinical
needs of health professional training programs in the area, as applicable.
C
In Project I.D. # F-11461-18, the application was conforming to this criterion and the
applicants propose no changes in the current COS application that would affect that
determination.
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information which was publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the applicants adequately demonstrate that
the proposed services will accommodate the clinical needs of area health professional training
programs, and therefore, the application is conforming to this criterion.
(15) Repealed effective July 1, 1987.
(16) Repealed effective July 1, 1987.
(17) Repealed effective July 1, 1987.
(18) Repealed effective July 1, 1987.
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 21
(18a) The applicant shall demonstrate the expected effects of the proposed services on competition
in the proposed service area, including how any enhanced competition will have a positive
impact upon the cost effectiveness, quality, and access to the services proposed; and in the case
of applications for services where competition between providers will not have a favorable
impact on cost-effectiveness, quality, and access to the services proposed, the applicant shall
demonstrate that its application is for a service on which competition will not have a favorable
impact.
C
The applicants propose a COS for the approved, but undeveloped, Liberty Commons of Mint
Hill project which authorized the construction of a new 83-bed nursing facility. In the current
COS application, the applicants propose to add 12 ACH beds to the approved Liberty
Commons of Mint Hill project by relocating 12 ACH beds from Radbourne Manor Village
(Project I.D. #F-11052-15) project for a total of 83 NF beds and 12 ACH beds at Liberty
Commons of Mint Hill upon project completion.
On page 211, the 2018 SMFP defines the service area for adult care home beds as “the adult
care home bed planning area in which the bed is located. Ninety-eight counties in the state are
separate adult care home planning areas. Two counties, Hyde and Tyrell, are considered a
combined service area”. Thus, the service area for this facility consists of Mecklenburg
County. Facilities may also serve residents of counties not included in their service area.
Based on data in Table 11A: Inventory of Adult Care Homes (Assisted Living) Beds in the
2018 SMFP, pages 226-228, Mecklenburg County has a total of 50 facilities with ACH beds
with a total planning inventory of 3,305 ACH beds including ACH beds with Agency approval
or license pending minus exclusions. Also, based on data in Table 11B: Adult Care Home
Need Projections for 2021 in the 2018 SMFP, page 239, Mecklenburg County is projected to
have an adult care home bed surplus of 360 beds in 2021.
In Section N, pages 55-56, the applicants describe the expected effects of the proposed services
on competition in the service area and discusses how any enhanced competition in the service
area will promote the cost-effectiveness, quality and access to the proposed services. On page 55,
the applicants state
“The applicants demonstrated in the original application the expected positive effects of the
SNF beds on the competition. In regard to this change of scope, the proposed project will
have a positive effect on the competition in the area, as the demand for these 12 ACH beds
may encourage other facilities with poor utilization in Mecklenburg County to improve their
current situations in order to compete. Access to ACH beds at Liberty Commons of Mint Hill,
especially to those residents in need of Medicaid and Special Assistance residents (over 1/3
of the 12 ACH beds will be reserved for Medicaid/Special Assistance), will allow admission
of residents who seek homelike care at lower costs.”
The applicants adequately describe the expected effects of the proposed services on competition
in the service area and adequately demonstrates:
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 22
The cost-effectiveness of the proposal (see Sections F and Q of the application, any
exhibits and the supplemental information)
Quality services will be provided (see Section O of the application and any exhibits)
Access will be provided to underserved groups (see Section L of the application, any
exhibits and the supplemental information.)
Conclusion
The Agency reviewed the:
Application
Exhibits to the application
Supplemental information requested by the Agency
Information which was publicly available during the review and used by the Agency
Based on that review, the Agency concludes that the application is conforming to this criterion
for the reasons stated above.
(19) Repealed effective July 1, 1987.
(20) An applicant already involved in the provision of health services shall provide evidence that
quality care has been provided in the past.
C
In Section A.1, page 5, the applicants state that Liberty Long Term Care, LLC (Liberty) is the
parent company of Liberty Commons of Mecklenburg, LLC. In Section A.10, pages 10-11, the
applicants provide a list of its affiliates which include 26 nursing home facilities and 4 adult care
homes located in North Carolina owned, operated or managed by the applicant or a related
entity.
In Section O, pages 58-59, the applicants state that, during the 18 months immediately
preceding the submittal of the application, incidents related to quality of care occurred in six
of the twenty-six nursing facilities: Woodlands Nursing and Rehabilitation Center, Warren
Hills Nursing Center, Liberty Commons Nursing and Rehabilitation Center of Rowan County,
The Oaks and Liberty Commons Nursing and Rehabilitation Center of Lee County. The
applicants state that all of the problems have been corrected as documented in Section O, pages
58-59 except for Woodlands Nursing and Rehabilitation Center which was awaiting a revisit
and expects to be in compliance as of November 6, 2018. According to the files in the Nursing
Home Licensure and Certification Section, DHSR during the 18 months immediately
preceding submission of the application through the date of this decision, incidents related to
quality of care occurred in eight of these facilities and all are back in compliance as of the date
of this decision. Furthermore, according to the files in the Adult Care Licensure Section,
DHSR during the 18 months immediately preceding submission of the application through the
date of this decision, incidents related to quality of care occurred in two of the four adult care
Liberty Commons Nursing and Rehabilitation Center of Mint Hill
Project ID #F-11607-18
Page 23
home facilities: The Commons at Brightmore and Liberty Commons Assisted Living.
According to the files in the Adult Care Licensure Section all are back in compliance as of the
date of this decision.
After reviewing and considering information provided by the applicants and by the Nursing
Home Licensure and Certification Section, the Adult Care Licensure Section and considering
the quality of care provided at all 30 facilities, the applicants provided sufficient evidence that
quality care has been provided in the past.
Additionally, the applicants were found conforming to this criterion in Project I.D. # O-11187-
16. Therefore, the application is conforming to this criterion.
(21) Repealed effective July 1, 1987.
(b) The Department is authorized to adopt rules for the review of particular types of applications
that will be used in addition to those criteria outlined in subsection (a) of this section and may
vary according to the purpose for which a particular review is being conducted or the type of
health service reviewed. No such rule adopted by the Department shall require an academic
medical center teaching hospital, as defined by the State Medical Facilities Plan, to
demonstrate that any facility or service at another hospital is being appropriately utilized in
order for that academic medical center teaching hospital to be approved for the issuance of a
certificate of need to develop any similar facility or service.
NA
In Project I.D. # F-11461-18, the application was conforming to The Criteria and Standards
for Nursing Facility or Adult Care Home Facility Services promulgated in 10A NCAC 14C
.1100 and the applicants propose no changes in the current COS application that would affect
that determination.
top related